Deb Haley, Medicare Insurance Broker

Answer: Licensed Medicare agents who I certified to and roll people in the available Medicare advantage and supplement plans in their state should not be charging the Medicare beneficiary any fees for doing the enrollment. Rather they are paid by the plan carriers when an enrollment is processed through them.

Answer: There are two enrollment periods during the year when you can change your Medicare advantage plan. The first plan is known as AEP and is the annual enrollment period from October 15th to December 7th. Changes you make during this period go into effect January 1st.

The next enrollment period is OEP which occurs January 1st through March 31st. Changes you make during this period go into effect the first of the following month.

There are other events that would allow to change your plan outside of the above enrollment periods known as special enrollment periods, for example a residential move.

Answer: You may enroll in original Medicare Part A and B, but you must also secure a part D plan to cover your prescription medications. If you do not have a Part D plan even if you don't take medications at all you will receive a late enrollment penalty.

Depending on your health needs and your budget it's always a good idea once you have Part A and B to look at Medicare advantage plan offerings in your area or a supplement plan with a part D added.

Most Medicare advantage plans include prescription coverage which satisfies the requirement to have a part D plan.

Answer: You may contact the social security or medicare office to report your card is missing and request a new one. They will either mail you a new card or if you believe your card was stolen you may request that they re-issue your Medicare Beneficiary ID Number and receive a new card.

Answer: You may change your standalone drug coverage or your medicare advantage plan during any valid enrollment period. You may also qualify for a SEP (special enrollment period) of which there are many including residential moves and weather related events.

Answer: Original Medicare covers medically necessary injectable and infusion chemotherapy medication if administered in a hospital setting and ordered by your healthcare provider as long as the drug is FDA approved for the condition you are being treated for. If you have a medicare advantage plan you will have a 20% copay. If you have a medigap supplement plan original medicare will cover the first 80% and your supplement plan will cover the remaining 20% once you have satisfied the annual deductible.

Answer: If you currently have Medicare because you have been disabled, when you turn 65 you do not have to choose a new Medicare plan or re-enroll in Medicare. However you do have a special enrollment period to do that if you would like to pick a new plan.

Answer: It's always a good idea to revisit your plan selections during the annual enrollment period when you can make those types of changes. Your prescription coverage may be included with your current Medicare Advantage plan or if you are on a supplement plan and have a standalone Part D for your drug coverage you can change just your part D plan if you find another plan has more favorable pricing. The only time you can change your party coverage is during the annual enrollment period which is from October 15th through December 7th.

Answer: Plan Fmedigap supplement plans include Part A and Part B services. There are no annual deductibles associated with Plan F. Therefore your emergency room visits should not incur any co-pays. Original Medicare should cover the first 80% and your supplement plan should cover the remaining 20%.

Answer: Indian Health Services is a government program that American Indians and Alaskans are eligible for. While they are also eligible for Medicare they do not have to use it. However Medicare may provide some additional benefits in addition to what they get thru IHS.

Answer: A good time to start preparing for the Medicate annual enrollment period is when you receive your annual notice of change letter from your plan carrier which highlights changes in copays, benefits, and other coverages for the upcoming year. Once you are aware of the changes you can decide if you need or want to compare what other plan carriers are offering in order to decide if you'd like to make a change during AEP. If you are working with a broker you could contact that agent on October 1st to start discussions. Enrollments cannot be done until October 15th. Any plan changes we'll go into effect January 1st.

Answer: Most all of the companies that offer a Medicare product starts sending marketing materials to prospective members several months before the member is turning 65. The amount of mail you receive can be overwhelming. For help comparing all the various plans and types of Medicare coverage you should go to Medicare agents hub put in your ZIP code and find a local broker who can help you with the process of choosing a plan and enrolling.

Answer: Every year your Medicare Plan carrier will send you an annual notice of change letter outlining any upcoming changes for the next calendar year. Usually you will receive this letter in September, prior to the start of the annual enrollment period on October 15th. It is very important to review the changes and determine if they affect you. During AEP you may wish to make a plan change based on your current plans upcoming benefit changes. When you make a change during annual enrollment. It becomes effective January 1st.

Answer: Depending on the types of medical services and the anticipated co-pays you will have, a Medicare Advantage or a mediab supplement plan maybe a good option for you. A Medicare Advantage plan may provide you with slightly lower copays under 20% and include several additional benefits for ancillary products and services. Whereas a Medicare supplement plan will act as a secondary to original Medicare and cover your 20% copays once in annual deductible is met. However the supplement plan does not usually include any additional benefits including prescription coverage so you would need at the very least to also enroll in a standalone Part D plan.

Either of these types of plans may help you to have lower overall costs.

Answer: Most medicare advantage plans cover cataract surgery. There is typically a copay for the "day surgery". The copay amount may differ if the surgery is performed at an ambulatory surgical center versus at the hospital. You will want to check with your plan carrier prior to the surgery to get estimated copays and confirm that the facility and doctor doing the surgery are 'in network' for your plan, as out of network may be covered at higher co-insurance amounts.

Answer: Having an agent or broker available to answer questions or help you is a nice alternative to contacting member services centers which may be unavailable during certain hours of the day. Your agent will typically get back to you quickly and you have the option of calling, texting, or emailing the agent for information. If the agent is unable to answer your question or help you they can coordinate a conference call with member services during normal business hours.

Answer: You are covered in other states if you are on either a Medigap Supplement plan or a Medicare Advantage PPO plan that is offered in the other state you spend winters in. Depending on whether your Medicare Advantage plan is with a carrier who contracts providers either in multiple states or nationwide you can find providers in Florida. If your plan only contracts providers in your home state then perhaps you should look at other options for either supplement plans or medicare advantage PPO so that you can still be covered for more than just 'emergency care' while in Florida. You may choose to enroll in a different plan during AEP.

Answer: There is a Medicare savings plan you could apply for that will help you pay your Medicare part B premium as well as some of your co-pays

Answer: If you are over 65 and still working AND ARE STILL COVERED UNDER YOUR EMPLOYER'S HEALTH INSURANCE and that insurance is considered 'creditable coverage' then you do not need to enroll in Medicare Part B at this time. Creditable coverage means that your employer has over 20 employees and that the insurance coverage is as good as what Medicare offers. It can be confusing to figure this out because there are variations that effect whether you need to pay for Part B or not, things like whether you are eligible for employer insurance which is usually determined by the company based on the number of hours you work. Creditable coverage can also depend on how many employees the company has. If you are going to continue to work and will be covered on the employer plan that meets the criteria above, you DO NOT need to enroll in Part B until about a month prior to the end date of your employer health insurance coverage. You will apply for Part B under a SEP (Special Enrollment Period) called "leaving employer group health plan" and would request Part B to start on the first of the month following your last date of coverage from the company.

Answer: The shingles vaccine is now covered like other vaccines under Medicare. For the two shot shingrad vaccine there is currently a $0 copay

Answer: One Medicare rule that is outdated and unfair is when someone is first eligible for Medicare and are allowed to enroll in just part A and they continue to work and contribute to an HSA account, once they enroll in Part A they are no longer allowed to contribute pre-tax dollars to their HSA account. They may also be subject to a penalty if they did not stop contributing to the HSA account 6 months prior to retirement. This is outdated and unfair to seniors who continue to work because most people these days do not plan their retirement 6 months in advance.

Answer: Medicare Savings Programs help eligible medicare beneficiaries with the cost of their Part B premium. In Massachusetts the program is called Mass Buy-In and the depending on which level of the program someone qualifies for there may be additional help with things like copays.

Answer: Most Medicare plans cover cataract surgery, however the lens you can choose must be either for distance or near. If you choose to have the upgraded lens that covers both you will have an additional charge. If you use a standard lens and need new prescription eyewear after the surgery there typically is no cost for the eyewear.

Answer: There is a special enrollment. When you move out of your residential area in which you have 60 days to re-enroll in a new plan.

Answer: In Massachusetts if your income drops below $2,824 a month for an individual for $3,833 for a married couple you can apply for a Medicare savings program that will pay your Medicare Part B premium and potentially some of your copays.

Answer: Most items that are covered under durable medical equipment by Medicare Will have a 20% copay to the member. Certain items such as a wheelchair with customizations may require a doctor's prescription and others, for example a shower chair, would not require a prescription. If you are enrolled in a Medicare Advantage plan you will want to check with the plan to ensure that you are using an in-network supplier to keep your cost at the lowest possible rate. And oftentimes places like senior centers will have received donations for things like transport chairs, walkers, shower chairs that you can borrow.

Answer: Yes, absolutely there should be stricter guidelines and rules that agents must follow when marketing and enrolling Medicare beneficiaries in Part C plans. And the private carriers of the Medicare Advantage plans should be overseeing their brokers who are contracted with them to ensure that they are following all the rules that apply.

Answer: Late enrollment penalties only apply if you do not enroll in Medicare parts A and B within 3 months after you turn 65 or within 63 days of your employer health coverage ending if you continue to work and are covered by the employer for health insurance after the age of 65.

Answer: You may switch to a lower cost supplement plan offered in your area. An example of this might be switching from a supplement G to a supplement N. You may explore discounts available such as same household discounts. Or you may want to consider moving from a supplement plan to a Medicare Advantage plan with lower upfront costs.

Answer: You should plan to look at all available plans in your area and find a broker who is licensed with several products so they can help you compare your options and costs. Check with your friends, relatives, neighbors, or coworkers for a referral to an agent that they worked with that did well by them. You may also check with your local senior center as many agents advertise or offer educational seminars there.

Answer: Starting in January of 2025 there is no longer a coverage gap (donut hole) which was formerly stage 3 Medicare prescription pricing. Instead it has been replaced by a $2,000 per year maximum copay amount. Once you have reached that maximum your co-pays will be $0 for your medications listed on your plans formulary for the remainder of that calendar year.

Answer: Creditable coverage is health insurance and prescription drug coverage that is as good or better than what is offered through original Medicare. If you have creditable coverage through an employer plan then you can delay in rolling in Medicare and avoid the late enrollment penalties.

Answer: Medicare typically doesn't cover experimental treatments, however it may cover certain testing required while the experimental treatment is going on but that would likely need prior authorization.

Answer: The drug formulary for each of the carriers is typically the same whether the medications are bundled in on their Medicare Advantage plan offering or on a standalone part D plan that they offer. The difference in price is that with the Medicare Advantage plan the prescription coverage is bundled in and there is no additional premium. The standalone Part D plans have a monthly premium that you pay in addition to your annual drug deductible s and copays. It would make sense to look at both options to see if there is a significant difference in price either way. The choice to go on a separate Part D plan may also be influenced by whether or not all of your medical providers are in network for a particular Medicare Advantage plan.

Answer: Good news! The coverage gap stage of prescription coverage, also known as the donut hole, was eliminated in 2025. There is now a $2,000 annual maximum out of pocket for your drug copays, after which you pay $0 copay for your medications for the remainder of the calendar year.